A USA TODAY NETWORK Tennessee report revealed the state's failure to oversee disability claims has created a system to enrich doctors who deny claims.

Alan Chrisman walks with his wife, Joyce, near the Sevierville, Tenn., McDonald's where he worked as a maintenance employee before being diagnosed with stage 4 colorectal cancer. Chrisman applied for disability but was initally denied by a medical contractor hired by the state to review claims.(Photo: Caitie McMekin/News Sentinel)

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The Social Security Disability program provides monetary benefits and insurance to our country’s most vulnerable citizens. Unfortunately, in Tennessee, it appears that the state has gone substantially off course in protecting the disabled.

Even more disturbing is that the General Assembly’s oversight committee, once charged with legislative oversight of DDS, was disbanded almost a decade ago, leaving DDS with little political accountability and leaving few politicians with the kind of systemic understanding of the disability system that this committee promoted.

In a partnership with the Social Security Administration, DDS decides cases at that first two stages of the Social Security Disability process. Historically, DDS in Tennessee has had nationally high levels of claim denials. Importantly, this reporting reveals, at least partially, why our state is such an outlier.

The extent to which the system is being stacked against the disabled is appalling. Certain "high producing" doctors decide a staggering number of claims, according to the article. Because they get paid per claim, the more cases they decide, the higher their compensation.

Last year, DDS paid a doctor $420,000 to review 9,088 files. This equates to one file every 12 minutes. To give you an idea of how absurd this is, I just finished preparing one relatively small file for a hearing before an Administrative Law Judge, and it took me two hours to properly read and notate his medical records.

Larger files can consist of several thousand pages of medical records and take much longer. There is zero chance this doctor provided quality records review (if records are reviewed at all) at that pace.

Moreover, billing at such an outlandish level raises the prospect of fraud by these “high producers.”

Even more disconcerting, the reporting confirms what practitioners have long heard about "quality control" practices — that they are a structural incentive to encourage denial. The DDS conducts quality control reviews of 50 percent of allowances (cases that result in payments). DDS shows no concern for individuals whose claims are denied, conducting quality control reviews on only 2 percent of denials.

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The result of “quality control” scheme is a medical consultant who improperly reviews 50 files. Even if one out of those 50 is reviewed and gets reversed, the agency can still hail this doctor for his 98 percent “accuracy rate.” If you are inclined to improperly bill the state, a doctor could just deny everyone and cash his check.

Significantly, each improper “denial” corresponds to a very, very sick person. In my practice, I routinely see individuals with conditions such as advanced cancer, multiple amputations, and advanced heart disease get denied at DDS. When individuals get denied by DDS, they face up to two years of waiting to get their claim decided by a judge.

In the interim, many become homeless. Most in Tennessee end up losing health care coverage and seeing their conditions worsen. It is not an exaggeration to say that an improper denial of a disability claim can get a sick person killed.

At least one whistleblower came forward about these practices, but DDS responded to the whistleblower and the news reporters with a shrug.

Even worse, the General Assembly currently has no committee engaged in oversight of this state agency. Though DDS is a part of the Tennessee Division of Rehabilitation Services of the Department of Human Services, no oversight committee has existed since Speaker Beth Harwell abolished them during her term.

A new General Assembly has now commenced, and Glen Casada, the new Speaker, has suggested reestablishing some of the oversight committees. The DDS’s disregard for those most vulnerable in our communities demonstrates why such oversight is essential.

We should encourage Mr. Casada to ensure that the reintroduction of Government Oversight Committees includes oversight of DDS. Only with proper oversight and a full investigation, can the General Assembly and our politicians remedy their contribution to DDS’ troubling behavior.

Robert A. Donati is an attorney with Donati Law and a Board Certified Specialist in Social Security Disability by the National Board of Trial Advocacy.